ST HELENA GOVERNMENT

TERMS OF REFERENCE

Community Psychiatric Nurse

1.Background

1.1 The island of St Helena is an internally self-governing Overseas Territory of the United Kingdom located in the South Atlantic approximately 4,000 miles from the UK. The Government comprises a Governor (who is appointed by the Crown) an Executive Council, which has the general control and direction of Government, and a Legislative Council. The Governor retains responsibility for internal security, external affairs, defence, the public service, finance and shipping.

1.2 The island’s population is around 4,500 and it has a typical small island economy with a high import dependency, a narrow economic base, a large public sector (around 790 staff), and significant outward labour migration. St Helena receives UK Government financial assistance to support recurrent and capital expenditure as part of their obligation to ensure that the reasonable needs of the population are met.

1.3 The 10 Year Plan for St Helena captures the following National Goals:

Altogether Safer

Altogether Healthier

Altogether Better for Children and Young People

Altogether Greener

Altogether Wealthier

The plan will improve joined up thinking, focus, and crucially reflect the views of the community. This can be found here:

1.4 The Prospectus for Change, launched in December 2015, is a three year plan which sets out St Helena Government’s Goals and Strategies for making the public service a great place to work, while ensuring customers experience the best possible service . This can be found here:

1.5 The vision and mission that has been agreed for the Public Service and which will be incorporated in future plans and strategies are as follows:

Vision – A great place to work and do business with

Mission – Provide Services that are responsive to the needs and expectations of the people of St Helena, by taking account of their views in decisions on the design, delivery and performance of services, and by working with our colleagues to create an environment that encourages everyone to do their best.

1.6Commercial flights to St Helena commenced on 14 October 2017. It is hoped that the tourism activity resulting from this will significantly enhance St Helena’s economic prospects and have a dramatic impact on the island community, bringing a period of accelerated social and economic change. Achievement of the Goals and Strategic Objectives will require sound management and transformation of the public sector to make it a professional, modern, and flexible organisation able to initiate and respond to change.

1.7SHG is implementing a modernisation programme that will enable the Public Service to improve its delivery of the government’s developmental objectives. Central to this programme has been the re-structuring of Government functions and directorates. There are currently five directorates reporting to the Chief Secretary who is the head of the Service; Education and Employment, Health, Safeguarding, Environment & Natural Resources and Corporate Services. The Police Service reports to the Governor.

1.8The Health Directorate strives to deliver a high standard of health l care andimprove the health status and wellbeing of the population. There is particular emphasis on reaching the vulnerable and those members of our community who are ‘at risk’. We aim to promote healthy lifestyles and reduce both the incidence and impact of non-communicable diseases.

1.9The directorate deliver medical, dental and nursing care, both in the community, at the primary care and at the secondary care level and also covers; environmental health (including solid waste management); pathology and microbiology services; pharmacy services, administrative services dealing with staff recruitment, budgeting, procurement, and overall support to other sections of the Directorate.

1.10Overview of Mental Health Services:

Mental Health services on the island are delivered by a community mental health team supported by the resident medical officers. There is also remote support from a Consultant Psychiatrist(based in Europe). The psychiatrist is scheduled to visit the island annually for consultation, care planning, service development and supervisory support to the team.

The local mental health team including this post will comprise of 3 community psychiatric nurses, a mental health social worker, clinical psychologist, educational psychologist and a support worker. One of these posts will undertake the role of mental health team leader. There are arrangements in place for clinical supervision and continuing professional development.

The active case load is shared amongst team members and comprise of clients requiring active supervision as well as continuing care. A key challenge is that there are no secure facilities for mental health care on the island and acutely unwell patients may need referral when 1:1 supervision becomes impractical.

The mental health team works in a coordinated manner with the safeguarding and education services on the island to give comprehensive support. There is a need for a more comprehensive offer around substance misuse, and general health promotion. These areas will be developed further and the mental health team can play a pivotal role in improving the overall wellbeing of the population.

2. Key Objectives

2.1 The overall objectives of the post ofCommunity Psychiatric Nurse are:

  • Implement and maintain quality mental health nursing care to the population of St Helena that is evidence based using best practice guidance, through assessment, planning, implementation and evaluation of care;
  • Manage the patients in the community, residential care and during hospital admissions with the support and supervision of the medical officer in charge of the psychiatric clinic;
  • Liaise regularly with the medical officer in charge of the psychiatric clinic regarding all patients seen and undergoing mental health treatment;
  • Communicate with relatives and significant others regarding support for clients when appropriate;
  • Run anxiety management and depression courses with support clinical psychologist as required;
  • Safely administer medications to patients;
  • Ensure all client/patient contacts are noted on the EMIS system on a daily basis;
  • Supervise learners/other care providers in the provision of patient care;
  • Effectively mentor student nurses ensuring the workplace is a stimulating learning environment;
  • Train and mentor staff in clinical areas and classroom;
  • Develop and implement a mental health promotion and prevention programme, including public talks, suicide prevention, and self-help groups;
  • Provide a mental health consultation and assessment service to other sectors including Education, Safeguarding, Learning Disability and the Prison Service, working closely with other professionals;
  • Organize the monthly telephone conference with the Supervising Clinical Psychiatrist in collaboration with the medical officer responsible for psychiatric patients and the other mental health nurses, and circulate beforehand to all participants the list of patients requiring discussion;
  • Provide enhanced nursing practice such as Cognitive Behavioural Therapy;
  • Seek the advice of the Supervising Clinical Psychiatrist as soon as possible in all cases of high risk, including hospitalized psychotic patients, actively suicidal individuals, and children and adolescent with severe mental health problems not responding to treatment; and
  • Other clinical and professional duties as appropriate including travelling with patients overseas during overseas transfers.

2.2General Requirements:

Cooperate fully with the Health and Safety arrangements in the Hospital, reporting any accidents/incidents/equipment defects to the line manager, maintaining a clean, uncluttered and safe environment for patients, members of the public and staff.

Adhere to all policies/codes of conduct, including for example:

  • SmokeFree policy, alcohol free policy.
  • IT Security, Official Secrets Declaration, and NMC Code of Conduct
  • Standard of attendance, appearance and behaviour

Responsible for all records held, created or used as part of patient care whether paper based or electronic, including emails. Represent the Directorates commitment to providing the highest possible standard of service to patients/clients and members of the public, by treating allin a pleasant, courteous and respectful manner.

2.3 Special Conditions:

Unsocial hours

Required to take part in on-call duties

Potential exposure to abusive/aggressive patients/relatives

Potential exposure to contaminated body fluids

Potential exposure to contamination of radiation from x-rays

3. Qualifications and experience:

3.1Essential

UK Registered Level 1 Mental Health Nurse (or equivalent)

A minimum of five years post registration experience,

3.2 Desirable

Dual qualification RGN/RMN

In-depth knowledge and specialist experience in one or more of the following areas:

Learning Disabilities & Neurodevelopmental disorders

The Elderly

Addiction

Cognitive behavioural therapy

4. Outputs, Timing and Reporting

4.1 The post is required as soon as possibleand will be for a period of two years.There is a possibility of a further extension upon satisfactory performance. The post is subject to a probation period of 6 months.

4.2 The post holder is required to work full time, 35 hours per week, on a rotating shift basis. The post holder will also be required to participate in 24 hour on-call duties for speciality area of practice.

4.3 The post holder will report directly to the Mental Health Team Lead.

5. Clinical Competencies:

5.1 Effectively plans, delivers and evaluates care, interventions and/or treatments to meet people’s health and wellbeing needs

  • Identify and implement the relevant overall care/treatment plan for patients that is consistent with evidence-based practice and/or clinical guidelines, identifying specific precautions or contraindications, whilst respecting the individuals privacy and dignity and ensuring patients consent is sought and given whenever possible.
  • Monitor individual’s reactions to care/interventions/treatment and takes the appropriate action to address any issues or risks.
  • Review the effectiveness of the interventions/treatments and other specific activities and makes any necessary modifications, ensuring feedback to the MO responsible for patients overall care.
  • Maintain accurate records of the activities undertaken and outcomes.
  • Respond to, records and reports any adverse events or incidents relating to the intervention/treatment with an appropriate degree of urgency.

5.2 Effectively assess physical and/or psychological functioning and development, monitor and review related treatment plans.

  • Determines and records diagnosis and treatment plans according to agreed protocols/pathways/models.
  • Monitors and reviews the implementation of treatment plans and makes changes within agreed protocols/pathways/models.
  • Identifies individuals whose needs fall outside protocols/pathways/models and makes referrals to the appropriate practitioners with the necessary degree of urgency.
  • Assess patients and provide short term psychological interventions including computerised and non-computerisedCBT programmes
  • Assess the elderly and be able to administer standardized assessments of cognitive function
  • Assess individuals with substance-related conditions and be able to provide motivational interviewing, care during detoxification, and long term follow up
  • Facilitate and lead expert patient groups in mental health presentations and support self-help groups in identified areas

5.3 Effectively communicates with patient’s relatives and explains the patient’s care with them as appropriate

  • Displays sensitivity to relatives’ level of understanding, culture, background, body language, feelings and emotions and preferred ways of communicating.
  • Identifies the purpose of the communication with the relatives and anticipates its effect, effectively explains the patients care in non-medical language.

5.4 Effectively mentors the student nurses and teaches junior members of staff, including classroom teaching

  • Lead on training and development of community psychiatric nurse in areas such as CBT, anxiety management and assessment tools and treatment packages
  • Provide opportunities for junior staff to observe and practice teaching
  • Mentor the student nurses ensuring their assessments are completed.
  • Use all available activity to teach student nurses and junior members of staff to develop their knowledge and skills.
  • Actively participate in the classroom teaching programme and in health promotion activities related to mental health.

5.5 Promote, monitor and maintain best practise in health, safety and security

  • Identify the risks involved in work activities and processes
  • Identify how to manage the risks ensuring others undertake work activities consistent with legislation, policies and procedures.
  • Take the appropriate action to manage an emergency, summoning assistance immediately when this is necessary
  • Report actual or potential problems that may put health, safety and security at risk and suggests how they might be addressed.
  • Support others in maintaining health, safety and security.

5.6Effectively supervise people’s work

  • Give people opportunities to contribute to the planning and organisation of their work.
  • Develop and explains plans and work activities to people and enable them to carry out their work effectively, consistent with legislation, policies and procedures.

6 Managerial Competencies

6.1 Proactively identifies the needs and expectations of service users and strives to meet these

  • Contribute to the development of an updated mental health strategy.
  • Ascertain and/or anticipate user requirements to ensure that where possible these are met.
  • Explain sensitive or complicated information in a manner focused on the service user’s perspective and understanding.
  • Establish positive relationships with service users.
  • Obtain regular feedback and act on it to improve customer service.
  • Always consider the impact on all service users when making decisions.

6.2 Ensures the quality of own work meets job requirements and encourages quality in others work

  • Works within the limits of own competencies.
  • Organises and prioritises own workload to ensure provision of a quality service.
  • Identifies opportunities to improve quality of own work and where appropriate underlying working practices.

6.3Pro-actively committed to developing own personal skills, knowledge and behaviours, in order to improve performance within current role and potentially prepare for career moves. Supports others in their development.

  • Undertake self review and seeks feedback from others on own work, and emerging job requirements.
  • Acknowledge own development needs, suggests areas for learning and agrees personal development objectives for current role and career development areas.
  • Take responsibility for own personal and/or professional development.
  • Take an active part in learning opportunities, evaluating the effectiveness of these and providing relevant feedback.
  • Maintain up-to-date portfolio of own development activities.
  • Contribute to the development of others (e.g. through sharing knowledge, skills, experience or information, acting as a coach or mentor, providing feedback,assessing, reviewing).
  • Contribute to developing the workplace as a learning environment.
  • Generate and uses appropriate learning opportunities and applies own learning to the development of practice.

6.4Able to appropriately and effectively use a range of communication approaches in order to inform, influence or persuade people in relation to more difficult subjects and/or situations.

  • Demonstrate the ability to respond quickly, constructively and honestly when challenged, encouraging input and feedback.
  • Think ahead and prepares well for situations that involve persuasion and negotiation.

6.5Enables the team to achieve objectives, through actively building and promoting an effective team, within a multidisciplinary environment.

  • Achieve commitment and ownership of the teams objectives through sharing responsibility with team members.
  • Demonstrate high standards of integrity, honesty and fairness, leading by example.
  • Keep team members informed and up-to-date about all relevant or useful information.
  • Support team members in delivering change.
  • Adopt an open, visible approach, actively participating in the team and being readily available to team members for discussion, advice or consultation.

7. SHG Competency Framework

Under the SHG Competency framework, this post holder is required to demonstrate the following competencies:

7.1 Professional Development

Requirements for Continuous Professional Development met and when necessary submitted to Professional Institute in order to continue recognition of professional status

7.2Planning and delivery of work

  • Manages own work activities so that work is delivered in an efficient and productive way. Ensures quality or service standards required are maintained.
  • Ask questions to clarify expectations when necessary.
  • Keeps relevant parties informed on the progress of a plan or programme.

7.3Analysis and use of information

  • Is able to identify when information received is relevant to and should be used in completing an activity.
  • Follows guidelines for identifying problems.
  • Gathers and summarises data when required.

7.4Decision making

  • Gathers information from appropriate sources to make routine decisions.
  • Solves problems that have implications for others in own team

7.5Working with others

  • Informs, consults and influences others using a range of communication mechanisms.
  • Engages with others to gather information
  • Shares and implements good practice with others
  • Works with senior management and other stakeholders

7.6Communication

  • Can write clearly without spelling or grammatical errors.
  • Uses jargon free language
  • Is able to record factual information accurately.

7.7Influencing and persuading

  • Is receptive to constructive feedback
  • Expresses a difference of opinion in an appropriately controlled and constructive manner.
  • Supports team members working on the same or related work activities.
  • Seeks clarification to ensure requests are understood

7.8Dealing with change

  • Sees change as an opportunity
  • Supports colleagues in understanding change
  • Participates readily in change initiatives
  • Assists others to accommodate change
  • Focuses on benefits to self and/or others

7.9 Continuous improvement

  • Makes business and efficiency improvements through use of appropriate systems and tools.
  • Able to coach and develop individuals
  • Shares knowledge and experience with others
  • Manages own development and performance
  • Learns lessons from both successes and failures

7.10Managing resources

  • Promotes and enforces appropriate business rules
  • Deals with varied situations with limited guidance